Before the 1950s, many of us suffered from poliomyelitis and too many ended up crippled. Then we developed a vaccine and eradicated the disease. Before the second world war, many people, even the richest, could die of a simple foot infection. Then we mass-produced antibiotics and got rid of the problem.
I have stated that it is basically a matter of time before we get the diseases of old age (cancer, stroke, dementia…) under control. It is impossible to tell when it will happen. Could be a couple of decades, could be 45 years, could be a century or a bit more. As a precaution, you should never trust anyone who says he can predict the future more than a couple of years in advance. However, progress that is not impossible in principle tends to reliably happen, on its own schedule.
Whenever we will get the diseases of aging under control, we will end up with drastically extended healthspan. Simply put, most of us end up sick or dead because of the diseases of old age. Without these diseases, we would end up healthy for much longer.
It comes down to the difference between having airplanes and not having them. Having electricity or not having it. Having the Internet or not having it. These are drastic differences.
Stating that the diseases of aging will come under control at some point in our future should not be controversial. And you would hope that people would see this as a positive outcome.
Not so.
The prospect that we may finally defeat aging is either rejected as being too improbable, or, more commonly, is rejected as being undesirable. Nick Bostrom even wrote a fable to illustrate how people commonly react.
The “improbable” part can always be argued. Anything that has never been done can always be much harder to achieve than we think. However, some progress is evident. Jimmy Carter, a 91-year-old man, was “cured” from a brain tumor recently. Not long ago, such feats were unthinkable. So it becomes increasingly difficult to argue that a few decades of research cannot result in substantial medical progress.
So we must accept, at least in principle, that the diseases of aging may “soon” become under control where by soon, I mean “this century”. This would unavoidably extend human life.
Recently, one of my readers had this very typical reaction:
As for extending human life, I’m not for it.
If you tend to agree with my reader, please think it through.
Aging does not, by itself, kills us. What kills us are the diseases that it brings, such a stroke, dementia, cancer. So if you are opposed to people living healthier, longer lives, then you are favorable to some of these diseases. I, for one, would rather that we get rid of stroke, cancers and dementia. I do not want to see these diseases in my family.
Medical research is a tiny fraction of our total spending. Medical spending is overwhelming directed toward palliative care. To put it bluntly, we spend billions, trillions, caring for people who are soon going to die of Alzheimer’s or cancer. This is quite aside from the terrible loss of productivity and experience caused by these diseases.
If we could get rid of these diseases, we would be enormously richer… we would spend much less on medical care and have people who are a lot more productive. The cost of aging are truly enormous and rising right now. Keeping people healthy is a lot cheaper than keeping sick people from dying.
Moreover, increased lifespans in modern human beings are inexorably linked with lower fertility and smaller populations. Lifespans are short in Africa and long in Europe… yet it is Africa that is going to suffer from overpopulation.
As people are more confident to have long lives, they have fewer children and they have them later. Long-lived individuals tend to contribute more and use less support relatively speaking.
If you are in favor of short human lifespans through aging, then you must be opposed to medical research on the diseases of aging such as dementia, stroke, and cancer. You should, in fact, oppose anything but palliative care since curing dementia or cancer is akin to extending lifespan. You should also welcome news that members of your family suffer from cancer, Parkinson’s and Alzheimer’s. They will soon leave their place and stop selfishly using our resources. Their diseases should be cause for celebration.
Of course, few people celebrate when they learn that they suffer from Alzheimer’s. Yet this disease is all too natural. Death is natural. So are infectious diseases. We could reject antibiotics because dying of an infection is “natural”. Of course, we do not.
Others object that defeating the diseases of aging (cancer, Alzheimer’s, stroke…) means that we become immortal and that’s clearly troubling and maybe unsustainable. But it is unfounded. Short of rebuilding our bodies with nanotechnology, the best we could probably do is make it so that people of all chronological age have the mortality rate they had when they were thirty. That’s a very ambitious goal that I doubt we have any chance of reaching in this century. And yet, people in their thirties die all the time. They simply do not tend to die of aging.
Yet others fall prey to the Tithonus error and believe that if we somehow get the diseases of aging under control, we will remain alive while growing increasingly frail and vulnerable. But, of course, being vulnerable is the gateway to the diseases of old age. You cannot control the diseases of aging without making sure that people remain relatively strong.
Others fear that only the few will be able to afford medicine to keep the diseases of old age at bay… It is sensible to ask whether some people could have earlier access to technology, but from an ethical point of view, one should start with the observation that the poorest among us are the hardest hit by the diseases of aging. Bill Gates won’t be left alone to suffer in a dirty room with minimal care. Healthy poor people are immensely richer than sick “poor” people. Like vaccines, therapies to control the diseases of old age are likely to be viewed as public goods. Once more: controlling the diseases of old age will make us massively richer.
I am sure that, initially, some people expressed concerns regarding the use of antibiotics. Who will benefit most from vaccines? Can you imagine contemplating this question when the Americans decided to mass produce antibiotics for the first time?
When the Internet came of age, many people wrote long essays against it. There were big fears that the Internet would create a digital divide, where the rich would jump ahead while the poor would remain disconnected. Yet, today, the poorest kids in the world have access to the same Wikipedia as Bill Gates’ kids. There were fears that the rise of computers would isolate people. Yet today the Internet is our social gateway.
Now that we are starting to think about getting the diseases of aging, people object. But let me assure you that when it comes down to it, if there are cures for the diseases of aging, and you are old and sick, you will almost certainly accept the cure no matter what you are saying now. And the world will be better for it.
Please, let us just say no to dementia, stroke and cancer. They are monsters.
Further reading: Nick Bostrom, The Fable of the Dragon-Tyrant, Journal of Medical Ethics, 2005.
Related books : Mitteldorf’s Cracking the Aging Code, Fossel’s The Telomerase Revolution, de Grey’s Ending Aging, Farrelly’s Biologically Modified Justice and Wood’s The Abolition of Aging.
While it is true that most of us will die of some disease that old age has made us more vulnerable to, I have seen relatives die slowly of old age itself. They have essentially wasted away, losing appetite and will to live as they have become too weak to do anything they love doing.
I agree that we will (and should) slay the monsters of alzheimers, stroke and other disease. This will, of itself, increase average lifespan by up to 20 years.
Old age is its own phenomena however. The cells that make up our bodies lose the ability to make accurate copies of themselves. They slow down in their ability to copy at all, making trivial cuts turn into dangerous wounds. Bones become brittle, and breaks become death sentences. Muscle tone becomes weak, until we are invalids. All of these without a direct disease involved.
Then there are some real practical questions. Perhaps we will develop anagathics. If so – who will get them. If they are very expensive (and I can’t see them being cheap – demand will see to that) will they exacerbate the class divide? Will progress slow to a halt as the population gets older and older, and people aversion to risk increases continuously? Will we (the entrenched older population) end up in warfare against the young that we will not step aside for? If the birthrate does not drop precipitously (and I think it would), how will the earth supply the ever increasing population without death by old age?
Many of these practical questions have ethical dimensions. I suspect that anagathics will be developed and their use begun long before we will have come to grips with these questions. Like all other fields of science, progress does not wait on ethics, but rather, we discuss our ethical qualms long after the damage has been done.
Many of these practical questions have ethical dimensions. I suspect that anagathics will be developed and their use begun long before we will have come to grips with these questions. Like all other fields of science, progress does not wait on ethics, but rather, we discuss our ethical qualms long after the damage has been done.
I do not agree. We are still a relatively long way away from anything that resembles a control on the diseases of aging. Not as far away as people think, but still comfortably far. And people spend a lot of energy expressing their ethical concerns.
I have seen relatives die slowly of old age itself. They have essentially wasted away, losing appetite and will to live as they have become too weak to do anything they love doing.
You have to define what you mean by “becoming weak”. Sarcopenia is a common medical condition where, indeed, muscles waste away. We all lose about 1% of our muscle mass every year. We have little data on it because it lacks recognition, but it does seem fairly easy to alleviate it, like diabetes. However, it is generally not treated at all, which is a problem.
Another common problem is depression. As we age, we become more likely to fall into depression. But, again, that’s probably treatable.
And so forth. One must define his terms… and what one means by “weak”.
In Canada, for 2012, here are the causes of death:
And so forth. Accidents represent less than 5% of all deaths. There is no “slowly dying of old age” as a cause.
The actual mechanism is that people become less fit as they age and more likely to fall sick and die. It is really that simple. They don’t die of aging per se.
Old age is its own phenomena however. The cells that make up our bodies lose the ability to make accurate copies of themselves. They slow down in their ability to copy at all, making trivial cuts turn into dangerous wounds. Bones become brittle, and breaks become death sentences. Muscle tone becomes weak, until we are invalids. All of these without a direct disease involved.
Aging is its own phenomena and it affects all of us starting at age 25 or so. We all become less fit and more prone to diseases with each passing year. But we cannot keep people who grow increasingly frail healthy. That’s simply not feasible beyond a certain point. You are not going to keep people free from cancer if their immune system is gone or dysfunctional.
People who currently live to a hundred did not catch cancer at 60 and Alzheimer’s at 70. They live to be a hundred because, at 80, they had the health of a 50 year-old (probably due to exceptional genetics).
You can, indeed, slightly extend the life of the very frail, and we have done some of that, but it only takes you so far. It gets exponentially more difficult to keep ever more frail people alive.
Then there are some real practical questions. Perhaps we will develop anagathics. If so – who will get them. If they are very expensive (and I can’t see them being cheap – demand will see to that) will they exacerbate the class divide?
I address the issue of cost in my blog post. A therapy that could prevent Alzheimer’s would likely very quickly pay for itself many times. Almost anything that could prevent cancer would pay for itself.
There is a scenario where you need some Moon dust or hand-crafted molecules to control the diseases of aging… but it seems an unlikely scenario. The thing is… any therapy that has billions of potential patients, and a strong preventive effect… is very likely to end up cheap. We do have such therapies right now, they are called vaccines. It is very expensive to produce one vaccine, but once you have it, you can administer it very cheaply to millions.
Will progress slow to a halt as the population gets older and older, and people aversion to risk increases continuously?
The absence of new technology in our case would lead inexorably to an ever growing burden caused by the diseases of aging. In Japan right now, a quarter of the population is above 65. We will soon reach the same levels and more. That too will have consequences.
If nothing changes, more and more people will need to spend more and more time caring for sick older people.
Will we (the entrenched older population) end up in warfare against the young that we will not step aside for? If the birthrate does not drop precipitously (and I think it would), how will the earth supply the ever increasing population without death by old age?
I also address this in my blog post. Countries where longevity is highest are precisely countries where the population count is falling. Defeating the diseases of aging brings about, at best, a slight increase in the population count everything else being the same. It is easily understood: it is the birthrate that drives population because it has an exponential effect… whereas old-age mortality has only a linear effect. Unless, of course, you think that old people are going to start having babies in great numbers… No impossible, mind you, but probably not in the cards.
Great essay and comment response Daniel. Thorough, enjoyable, and well communicated. It is a shame that we have to continually counter the same old arguments, fallacies, and protests to life- and health-span extension. You’ve provided a valuable contribution here.